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When the patient showed up in the emergency department, he was hurting. He'd taken a nice long soak in a warm tub, and a few hours later his fingers swelled enough to trap his ring. Now that finger was painful and swollen. The ring needed to come off, since restricted blood flow can lead to tissue death in the finger, which is about as fun as it sounds.

Ordinarily, this wouldn't be much of a problem. ER personnel are used to removing rings. "It's not uncommon at all," says Dr. Bret Nicks, an emergency room physician at Wake Forest Baptist Medical Center in Winston-Salem, N.C., who says he and his colleagues see traumatic injuries from working with heavy machinery such as cars or even the odd softball misfire. A published review of the problem also names "infection, skin disorders, allergic reactions, bee sting, and pregnancy" as causes for trapped rings.

Usually they can be removed using lubrication, elevating the hand or this nifty string trick. And if that fails, out comes the ring cutter. But as two physicians describe in a letter published online Thursday in Emergency Medicine Journal, this patient's ring was made of titanium.

Titanium rings are growing in popularity because they're very strong, light, hypoallergenic and less expensive than rings made of precious metals like gold or platinum. But that strength can also make them more difficult to remove. A normal ring cutter won't necessarily work, says Dr. Andrej Salibi, a plastic surgeon at Sheffield Teaching Hospitals in the U.K. and co-author of the letter. Jewelers who work with titanium say the commercially pure grades are much softer and easier to cut than aircraft grade, an alloy that also includes aluminum and vanadium; the exact type of titanium in this patient's ring isn't known. And of course the degree of difficulty can be boosted by the thickness of the ring.

In this case, the ring cutter failed, and the fire department came in with its own specialized cutting gear. The ring wouldn't budge. The patient was admitted to the hospital and spent the night with his hand elevated. The next morning one of the physicians suggested they try something else, namely bolt cutters, which are often on hand in hospitals.

It worked! But "the other problem is that once you cut it, you have to take it off," says Salibi. And that takes a lot of force. So using some large, heavy-duty paperclips, the two physicians pulled the ring apart. The man's finger was fine. The doctors say bolt cutters are preferable to dental saws or diamond-tipped saws, which aren't likely to be lying around the hospital and require more manpower.

Nicks, too, says bolt cutters can come in handy when other methods have failed. As with so many things in medicine, prevention is preferred, he says. "Any time you're working with heavy equipment, take your ring off." And if your hand is injured in any way, take off your rings immediately, before the swelling gets bad.

Calla Gold, a jewelry designer in Santa Barbara, Calif., says titanium rings can't be as easily sized as traditional metals, which is why she doesn't use them as wedding jewelry.

"Let's face it, your finger doesn't stay the same size" over the years, she says. Rings made of all metals can get stuck, and Gold has a list of suggestions for removing them. If those at-home methods fail and there's a jeweler handy, he or she might be able to help, Gold says. And if that doesn't work, head to the ER.

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